A bottle of tramadol

America is undergoing a massive opioid anxiety attack. It has been called an epidemic by lawmakers and the media. While many people used opioids responsibly for chronic pain, there has been substantial abuse and way too many deaths. As a result of scary headlines and DEA crackdowns, many physicians have become understandably fearful about prescribing drugs like hydrocodone (Lortab, Norco, Vicodin) or oxycodone (OxyContin). Instead, doctors are turning to different kinds of pain relievers. But one commonly prescribed drug for pain is not benign. Tramadol (Ultram) side effects can be quite serious. This reader shares a poignant story:

A Tramadol Tale of Woe and Intrgue:

Q. Last February my 84-year-old mother had pain in her lower back due to a car accident. The doctor prescribed tramadol (Ultram). She took it for several months. It helped with the pain, but we did not realize that the problems she had were side effects that the drug was causing.

The most serious one was shortness of breath. The doctor prescribed an inhaler, and was about to refer her to a pulmonologist. Other adverse reactions included confusion, lack of appetite, depression, anxiety and very high blood pressure (we took her to the emergency room in April for blood pressure of over 200 with shortness of breath).

They did not find anything, but prescribed more blood pressure medicine. Around July she stopped taking the tramadol and she soon realized that she was no longer short of breath. Gradually she was back to her old self, with purpose, less anxiety, and able to breath well.

Perhaps the doctor should have realized that the shortness of breath was due to the tramadol. Perhaps I should have read the sheet that came with the medicine. I wonder if any other patients have had a similar experience.

How Does Tramadol Work?

A. Tramadol (brand names Ultram & Ultracet) is a very complicated medication that was first approved by the FDA in 1995. It is a moderately powerful prescription pain reliever that has some “weak” opioid activity. That means it acts a bit like a narcotic.

It was supposed to be safer than most pain relievers, which is why it is not categorized as a “controlled” substance (the way Vicodin, OxyContin or hydrocodone are). Doctors could prescribe Ultram without using a DEA (Drug Enforcement Agency) number. That reassured many health professionals. The DEA would not come after them the way it might if they were prescribing oxycodone.

Tramadol Was Not Supposed to be “Addicting”

In the early days there was a belief that tramadol was much less likely to cause dependence than most other narcotic-like analgesics. In other words, there was not supposed to be an abuse potential (doctorspeak for the drug was generally considered non addicting). In theory, this pain reliever was supposed to have a low likelihood for producing withdrawal symptoms upon discontinuation, especially when compared to narcotics like hydrocodone or oxycodone.

A Little-Known Tramadol Effect:

We suspect that most health professionals do not truly understand the pharmacology of tramadol. They know that the DEA won’t spank them for prescribing it. They know it is not as potent as hydrocodone or oxycodone.

But do they know that tramadol also affects neurochemicals such as serotonin and norepinephrine? That means the drug behaves a little like antidepressants such as Zoloft (sertraline, which is an SSRI or selective serotonin reuptake inhibitor) or Effexor (venlafaxine an SNRI) in the brain. Tramadol has not been approved to treat depression, however. More on this effect (and its complications) in a moment.

The problem with theories is that they don’t always work out the way they are supposed to. In the case of tramadol, there are a number of side effects and complications that were not necessarily anticipated.

Tramadol (Ultram) Side Effects:

• Dizziness, unsteadiness, vertigo, coordination difficulties
• Nausea, vomiting
• Abdominal pain, indigestion, diarrhea
• Constipation
• Sleepiness, drowsiness, fatigue,
• Itching, skin rash (could be life threatening!)
• Sweating
• Dry mouth
• Anxiety, confusion, nervousness, cognitive dysfunction
• Headache
• Insomnia
• Seizures
• Respiratory depression, breathing difficulties (shortness of breath)
• Suicidal thoughts
• Low blood pressure on standing, hypertension, irregular heart rhythms
• Serotonin syndrome

Responding to Our Reader’s Concerns:

Your mother’s side effects including her breathing difficulties, confusion, lack of appetite, hypertensive episode and depression could all have been tied to tramadol. The drug can trigger something called serotonin syndrome, especially in combination with certain other medications. You can read more about serotonin syndrome at this link. It can be potentially life threatening.

Tramadol and Older People:

The Swedish National Board of Health and Welfare has included tramadol in its list of drugs to (BMC Pharmacology and Toxicology, October 25, 2017):

“avoid unless special reason for prescription.”

The Swedish researchers consider tramadol a “potentially inappropriate medication” in older people, especially if they are identified with “intellectual disability.” In other words, if someone is confused, they may become more confused while taking a drug like tramadol (see anticholinergic effects below).

Similar Stories from Readers:

O.G. reported:

“My doctor (and the orthopedist to whom I was referred for severe hip pain) prescribed Tramadol for recurring pain. I was nauseated, dizzy, had hot flashes, and many of the other side effects this supposedly safe drug causes.

“When I tried to stop I went through what I can only describe as withdrawal. It lasted for about 48 hours. When it was over it felt like coming out from under a cloud. This from a patient like me who is careful in her use of medications.”

Mac in South Carolina shared this:

“I took tramadol for a brief time for back pain. I tried it on three different occasions. I experienced extreme vertigo, nausea, diarrhea, and a migraine-like headache with just one dose each of those times. I had to hold on to the wall to get myself to the bathroom without falling down and could not tolerate bright light. This lasted for days.”

C.S. In Florida was also sensitive to tramadol (Ultram) side effects:

“I was prescribed tramadol for pain. After only 3 doses I experienced nausea, severe vomiting, headache, tingling in both arms and disorientation. I feared I was having a stroke and went to the emergency room. A CT scan revealed no stroke.

“I would never take this medication again. When I go to see any doctor I list tramadol in the ‘allergic to’ section of medical forms so I am not prescribed it again.”

Tramadol and Anticholinergic Activity:

Very few physicians realize that tramadol also has anticholinergic (AC) activity. That means it interferes with the action of the crucial brain chemical acetylcholine. This might explain why the woman who contacted us described her mother’s “confusion” as a possible complication of tramadol.

Learn more about the impact of anticholinergic drugs at this link:

“Are Anticholinergic Drugs Bad for Your Brain?

Tramadol has weak AC activity. But if someone were taking other drugs that also have this effect, the total AC burden could become problematic. This is especially true for older people. Here is a link to more information on drugs with anticholinergic activity.

Tramadol (Ultram) Side Effects & Withdrawal

Perhaps the most disturbing and unanticipated problem with tramadol is withdrawal. Even though most health professionals thought the drug would not trigger this problem, we now know that it not only happens but can be disastrous.

In addition to the narcotic-like action of tramadol, the drug also behaves a bit like antidepressants such as paroxetine, sertraline or venlafaxine. At the time it was approved, the FDA may not have realized that when such drugs are stopped suddenly, people can experience very unpleasant withdrawal symptoms.

This dual action (the narcotic-like effect and the serotonin “discontinuation syndrome”) can lead to some terrible symptoms. Patients are not always warned about this problem.

Tramadol Withdrawal Symptoms:

• Anxiety, mood swings, irritability
• Brain zaps (shock-like sensations), tingling
• Sweating, chills, goose bumps, shivering
• Tremors
• Headaches
• Insomnia, sleeping difficulties, nightmares
• Flu-like symptoms
• Nausea, vomiting, diarrhea, loss of appetite
• Depression
• Hallucinations, unusual thoughts
• Aggresiveness

Here are just a few of the many stories we have received about this complication:

Keiko clearly experienced withdrawal after stopping tramadol:

“I had surgery on my shoulder for a partial rotator cuff tear and manipulation of my frozen shoulder at the same time. The doctor ordered for PT to begin very next day. I was taking tramadol, but starting to feel strange so I stopped taking it abruptly.

“By midnight I was having cold chills and the sweats all night long. By the next morning I was vomiting. In addition to sweating profusely and cold chills I had severe anxiety. I was ended up in ER that afternoon. Apparently, I was having withrawal from tramadol. It was a horrible experience. I do not want to ever experience the “withdrawal” symptoms again.”

Lorraine reports that tramadol withdrawal was awful:

“I took tramadol for just over 30 days prior to having a hip replacement. I then took the pills for a week after surgery. Then I stopped.

“The withdrawal for me was worse than recovery from the surgery. I had flu like symptoms and was depressed (something I had never experienced). It took about 3 weeks to feel somewhat normal. I would never take this drug again!”

 Anonymous in Pennsylvania:

“Contrary to what doctors may say, this drug is very addictive. Use it sparingly and carefully. There is a small percentage of people who seem to be able to stop this drug cold turkey and not experience withdrawal. They are very lucky.

“More and more it’s becoming recognized that tramadol is an addictive drug and causes terrible withdrawal for many. The worst of it will last anywhere from 2 days to 2 weeks and then, depending on how long you’ve been taking the drug, you may continue to experience withdrawal symptoms for months afterward.

“I can’t even begin to explain how bad the withdrawal is. If you look it up, you will find numerous reports and testimonials from others who are trying to get off this drug and can’t because the withdrawal is so bad. Others can vouch for the hellaciousness of it.

“For me the worst physical symptom was constant restless legs. Emotionally, I was extremely depressed and had zero energy. Just lifting my arm felt like a huge effort. Going up and down the stairs put me out of breath. My internal thermostat was totally out of whack. I was hot one minute, and cold the next. My hair and clothes would get drenched from night sweats.

“The list goes on and on. I don’t EVER want to go through that kind of withdrawal again. I’m not saying don’t take this drug. But do be careful and try to stay on it for only as short a length of time as possible. Oh, I should also note I had a seizure while withdrawing from tramadol, which is not uncommon when coming off this drug.”

Generic Tramadol Issues:

In addition to the side effects and withdrawal symptoms associated with sudden discontinuation of tramadol, there is also the generic drug concern. We have heard from a number of people that not all generic versions of tramadol are created equal:

P.J.B. reported the following:

“I was taking the generic version of Ultram (tramadol) for several years when my pharmacy suddenly changed manufacturers (and did not point it out to me before I left the pharmacy with it).

“I gave them the benefit of the doubt, but within 24 hours of taking the other generic, I knew something was terribly wrong. All of my pain symptoms returned overnight, accompanied by extreme anxiety.

“I had to jump through hoops with the pharmacy but managed to get my doctor to write the script as DAW [dispense as written] and within an hour of taking the ‘Ultram,’ I felt completely different. The anxiety disappeared along with the lower back and leg pain.”

Jim also had generic drug trouble:

“When my doctor prescribed Ultram for my neurologic pain, it worked. I was nearly pain free for a few hours. When the pharmacy changed to the generic tramadol I never had total pain relief for any length of time.”

The People’s Pharmacy Perspective on tramadol:

Some people do well with tramadol. It this drug relieves their pain without side effects we are delighted. Others, however, may get modest pain relief and suffer symptoms such as dizziness, nausea and confusion. Older people may be especially vulnerable to such complications. Here is our bottom line:

• Tramadol can ease pain somewhat, but has a number of serious side effects (see above)
• Tramadol should not be discontinued abruptly. It can trigger terrible withdrawal symptoms for some people.
• The FDA has not provided physicians with clear guidelines on how to help patients phase off such drugs. We frequently see recommendations like “gradual withdrawal,” but no one bothers to provide clear instructions about what that really means.
• Do not assume that all generic tramadol formulations are identical to Ultram or each other.

If you experience any side effects, withdrawal symptoms or complications with a generic version of tramadol, contact your physician and pharmacist and request the help you deserve. Let your doctor know if tramadol is causing symptoms such as dizziness, nausea, drowsiness, dry mouth, insomnia or confusion.

Share your own story or comment below.

Revised 10/30/17

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  1. Julie
    South Carolina

    I always read patients’ comments but never comment on my own. Now I want to chime in on the seriousness of Tramadol withdrawal. I sustained an insufficiency fracture of my sacrum due to osteoporosis. After having terrible side effects from oxycodone my doctor prescribed Tramadol. I took four a day for two months, three a day for two weeks, two a day for an additional two weeks, and finally one a day for one week. Then I stopped.

    The first side effect I noticed was a feeling of anxiety. Then came the insomnia. Also felt like I had a stomach virus times three. I am now on day four and have contacted my Doctor who dismissed my symptoms as normal. My only recourse is to go back on it, and taper off again more slowly or suck it up. I choose to later. People need to be very aware of how dependent you can become on this drug.

  2. Carrie

    I was diagnosed with Reactive Arthritis in January 2014. The pain started in Nov 2013 in just the left knee and rapidly spread to the major tendons of both knees, shoulders, jaw and hips. The inflammation in my jaw has caused permanent tinnitus. I really didn’t think it could get any worse.

    Come Christmas I was put on a prescribed anti-inflamatory drug that did nothing for the pain. Nothing at all. I winced to lift my leg in and out of the car. I had trouble walking and had to quickly elevate it with ice when I got home. I was suffering. When it started to spread to other joints I could hardly dress myself or lower my torso to the commode. Can you imagine this? The pain was just that unbearable.

    My orthopedic doc referred me to a rheumatolgist whom I saw the first week in January. I was wheeled into her office in, get this, a wheelchair. She prescribed Sulfasalazine and Prednisone. Within 10 weeks I was finally put on Humira. But the damage was done. Although I could move better the debilitating pain was still there to such a great degree it was lowering my quality of life.

    Before this diagnosis I was a happy, healthy, and active 51 year-old women who loved to partner dance 4 x a week. Over the course of treatment my final medicine protocol was Enbrel, Celebrex and Tramadol and limited Tylenol. I wish I didn’t need to take any of these meds, yet because of them I have some quality of my life back.

    Tramadol works for me at 50mg-100mg per day and on non-flare days I don’t take it at all. Chronic pain suffering is cruel and ruthless. All these meds are poison in my opinion yet without them I had no life at all.

    I have had doctors who scoffed each time I switched insurance coverage at the Tramadol insisting I go on a different poison that had worse side effects that at each time outweighed any pain relief they provided, like Lyrica, Cymbalta, Effexor… the list goes on. Why would they take away what is working? I literally could not stay in the correct lane of traffic while on Gabapentin. Although it did wonders for my pain I was stumbling into walls, had horrid constipation, nightmares and bladder irritation IC flares. I mean, my gosh, this absolutely was just not worth the joint pain relief so I stopped taking it. I understand it is a godsend for other sufferers. And I can respect that. I also understand the above drugs are very, very difficult to get off of. Another drawback.

    For me personally, I would rather take medicine I need for that day as apposed to one I must take daily or suffer withdrawals if I don’t. Tramadol simply gives me the needed pain relief without debilitating side effects. I agree with those who suffered greatly while taking it and chose to stop it. Medicine is, after all, not an exact science. Do what works for you. And respect that what doesn’t work for you just may be the magic drug that works for others.

    Biologics are great medicines that work well until they stop working. I was subsequently switched to Remicade in June 2018. I hope that it continues to work for me as long as possible. In spite of the biologic treatment I was still unable to do most things like short walks, climb 4 stairs, or squat down without tremendously increasing inflammation pain that would last the rest of the day and kept me inside on the sofa. Tramadol is what helps the untreatable pain from reaching an 8 on the pain scale and helps me indure more physical activity for which I am eternally grateful.

    Many people with autoimmune conditions such as mine have posted the many trials and errors of biologics but that doesn’t mean we should not prescribe them to those they are helping. This mindset just doesn’t make sense to me. Does it make sense to you?

    The day Tramadol is taken off the market in the U.S. is the day I move to a Country that provides it.

    I hope my story has provided another outlook on the positive use of Tramadol and the quality of life it has given to me and many others who suffer from unrelenting life-long chronic pain.

  3. Nick
    Houston, Texas

    I had a herniated discs in my lower back that caused severe left leg pain constantly. I get my healthcare through the VA and of course the have completely stopped prescribing narcotics unless you’re dying, had surgery or have amputations. I was prescribed tramadol and it worked like a charm. I took it from December of 2017 and started trying to come off the medication after my discetomy and hemilaminotomy on August 1, 2018. My dosage was two 50mg pills every 4 hours. (About 8 months).

    My doctor told me that this medication isn’t a narcotic so it isn’t addictive and is safe to take. I don’t think doctors read up on anything that they prescribe, they just listen to the sales rep and on they go with it.

    One time prior to this, I ran out and was feeling extremely unwell. I had constant brain shocks. It felt like my brain was under a constant supply of low voltage electricity. It would worsen if I darted my eyes or turned my head to look around. That was the most uncomfortable and confusing part. I had a horrible loss of memory and lost the ability to think quickly and sharply. I felt like I would constantly lose my train of thought and forget easy to remember things. My entire body ached. I felt like I had the worst flu I had ever had. Extreme night sweats, nightmares, swollen tonsils, horrible back and front neck pain and stiffness, headaches, pain behind my eyes, slight joint stiffness and no appetite. I went to the ER at the VA and the ER doctor said it’s not withdrawal because tramadol isn’t addictive. Well, turns out he’s not very knowledgeable. He said I was dehydrated. I spent a lot of time in Iraq in full gear in the middle of the summer where temps would reach 120 degrees. Trust me, I know what dehydration feels like, this wasnt it. They gave me an IV and the shot version of tramadol and sent me in my way. I got the tramadol refill and felt 100% once I started taking it again.

    Well, I had my surgery and tried to stop taking the pills. Bad move. All the symptoms are back and I don’t know what to do. I’m trying to take one pill when I would normally take two but that doesn’t seem to be helping much.

    My doctor will be reading this article (had to close my eyes and put my head down for 2 full minutes to think of the word article, happens all the time) and will get an earful from me. I told my friend yesterday, “for all the pain and suffering I’m going through now, i wish the medicine would have at least made me high when i took it, maybe then this would be worth it haha.” I hope all reading this will have an easier time coming off the medicine. Hopefully I can find an answer and a solid solution to this

  4. Carolyn

    I have been taking tramadol (50mg 3 x a day) for six years. I would like to get off and see if I can handle the pain any other way but am terrified of the withdrawal. I spoke to a pharmacist who instructed me to cut back one quarter of a pill every 10 days and I would not have the withdrawal symptoms. I am going to try.

  5. Larry
    Cleveland Ohio

    I have been on Tramadol for a year and a half I’m so ready to put this phase behind me. Yes, I loved the feeling that it gave me but once I tried to go without it. That’s when my body started to feel weird. I have yet to come off but I’m cutting the dosage down and will be on my way to ending this battle.

    • Kate
      Pacific Northwest

      I took my last Tramadol 10 days ago. I had been taking 4 pills a day for a year, then dropped to 3 pills for 3 years. The withdrawal has been brutal. My Rheumatologist encouraged me to do this. I live in Oregon & used cannabis to treat the withdrawal symptoms (RSO saved me) & will use it to manage my chronic pain. I ingest it & suffer no side effects. I’ve had 2 surgeries, took Vicodin for one & Vicodin/Percocet for the other. I used as prescribed & had no problems stopping when I no longer needed the meds.

  6. Ronnie

    I weaned off Tramadol by halfing my doses. 4 days 1/2, 4 days another half….I’m off it completely for 2weeks now….but I am dealing with the extreme fatigue of said weaning.
    It’s gets a little better every day, the trick is not to rush it, and yes, I’ve had to wean off the drug 3 times now.
    Good luck to all who attempt it. You learn every try.

  7. Andi

    No one wants to become addicted to any substance or for a loved one to become dependent. Having said this, I think politicians and the media have created an unnecessary hysteria. The fault lies with drug manufacturers and doctors,( a lot of corruption); gifts, bribes, free vacations from pharma to doctors. Read expose “Blood Medicine.”
    But somehow, in the end, it is the patient ‘s fault , who is then stigmatized . There are many people who would not be able to work ,exercise, or make a living because of chronic unbearable pain.without a drug like Tramadol. And there are those that do perfectly well without side effects.
    The problem is when draconian drug policies are implemented without much warning, the govt. is interfering witb the sanctity of the doctor-pt. confidential relationship causing distrust between them; unless a politician happens to be a pain management specialist, he/she has no right to be making healthcare decisions for broad groups of people; no one’s brain body, pain is the same. Interfering in the judgment of a physician who has had years of medical training is simply wrong. Patients are lied to, doctors accept major gifts and bribes from sales reps to prescribe certain medications. Many very harmful, non-narcotic drugs too. Who profits? The black market… Portugal has no prohibitions against any drug, and much less drug abuse than countries that do. We are living in a police state…Think about it; it’s not just about tramadol, it’s about big brother.

  8. Rapuruchukwu
    Enugu Nigeria

    I have been on tams for 3yrs since i amputated my right leg,i take 200mg a day,it make me sweat alot all the time ,i experince stomach fullness all the time even when am not on it because i may take it for 3days in a week but whenever i stop for that week i still experince stomach fullness,hope that not really bad.someone help please.

  9. Shy

    I have had bad, hospitalizing migraines since I was little. So after a three day migraine and no break in it, I call my new doctor for my normal demeral shot to break my migraine. New doctor informed me they don’t use demeral and would give me tramadol. It broke my migraine, with side affects of bad dizziness, nausea & impossible to go to sleep for 6 hr. So 6hr later my migraine is back full force. And I still have all the side affects.

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